# EAST TEXAS PHYSICIAN ALLICANCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Magnolia Health Systems
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316250111
- **Authorized official:** MRS. KIMBERLEY GIBSON (ADMINSTRATOR)
- **Authorized official phone:** (903) 731-4700

## Contact information

- **Practice address:** 3201 S LOOP 256, PALESTINE, TX 75801-6901
- **Practice address phone:** (903) 731-4555
- **Mailing address:** PO BOX 4550, PALESTINE, TX 75802-4550
- **Mailing address phone:** (903) 731-4555
- **Mailing address fax:** (903) 731-4699

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367A00000X | Advanced Practice Midwife | — | NULL | Yes |
| 367A00000X | Advanced Practice Midwife | — | — | Yes |

## Other

- **Enumeration date:** 07/21/2010
- **Last updated:** 07/21/2010